Effective Nov. 1, 2017, UnitedHealthcare will start an online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for our fully insured UnitedHealthcare Commercial Plan members. While this program will be national, laboratory services ordered by Florida network providers for fully insured UnitedHealthcare Commercial Plan members in Florida will not have to participate in this requirement due to their participation in the UnitedHealthcare Laboratory Benefit Management Program.
UnitedHealthcare has contracted with a vendor to provide an on-line system to obtain online prior authorization/notification information and communicate UnitedHealthcare coverage decisions. Clinical information may be requested to determine if the request meets UnitedHealthcare’s clinical policy requirements for coverage; requests that meet UnitedHealthcare clinical criteria will be granted an authorization at the time of the request. UnitedHealthcare will only authorize payment for those CPT codes that have been registered with the Genetic and Molecular Testing Prior Authorization/Notification Program for each specified genetic test. Training opportunities and additional information about this program will be available on UnitedHealthcareOnline.com around Oct. 1, 2017.